Access and Reimbursement

Reimbursement

Financing Technology

Billing Compliance

Audits

Accounts Receivable

Denials

Revenue Cycle Management

Billing & Collections

Value-Based Care

Personal Health Records

Coding & Documentation

Medical Billing & Collections

Overhead

Finance

Industry News

OSHA

Medicare

Medicaid

Healthcare Policy

Malpractice

Risk Assessment

Safety

MACRA

Opioids

Mergers/acquisitions

HIPAA

Embezzlement

Healthcare Reform

Legal Compliance

Contracts

Risk Management

Stark

Law & Malpractice

Social Determinants of Health

Technology and Patient Engagement

Patient Care

Marketing

Patients

Patient Portals

Patient Flow Wait Times

Patient Relations

Payers

Patient Dismissal

Patient Confidentiality

Patient Engagement & Communications

Practice Management

Retirement

Surveys

Practice 360

Locum Tenens

Practice360 Blogs

Practice360 Articles

Practice Expansion

Banking

Pharmacy

Healthcare Careers

Investment

Primary Care

Business

Salary

Safety and Error Prevention

Front Desk

Employment

Jobs

Managers & Administrators

Hiring Firing

Career

Mentoring

Staff

Staff Salary Survey

Self Pay

Scheduling

Training

Work/Life Balance

Residents

Operations

Outsourcing

Partnerships

Performance

Practice Models

Productivity

Recruitment

Red Flags

Practice Management Systems

Physician Productivity

Personal Finance

Physician Compensation

Referrals

Burnout

Staffing & Salary

Cybersecurity

Remote Patient Monitoring

Telemedicine

Vendors

Voice Recognition

Health IT

EHR Technology

Hardware

E-prescribing

Technology Survey

Stimulus

Mobile

Data Analytics

Technology

Utilizing Medical Malpractice Data to Mitigate Risks and Reduce Claims

Topics

MedMal by Coverys

Media

Video & Interviews

Podcasts

Medical World News

Pearls

Best States to Practice

Great American Physician Survey

Conferences

ACP Internal Medicine Meeting

HIMSS

MGMA

All Conferences

Events

Virtual Events

CME/CE

Resources

Partners

Publications

Subscribe

a company that specializes in strategic healthcare initiatives such as mergers and acquisitions, management services organizations, private equity, succession planning, physician partnerships, and strategic planning. He can be reached at 

Articles

While analyzing the competition is an essential component of your strategy, most medical practices don't conduct this type of analysis systematically enough.

Are you working on a 2025 strategy?

Ryne Natzke is Chief Revenue Officer at TrustCommerce, a Sphere Company.

Practices have tools at their disposal that can help alleviate some of the problems that women face with health care affordability and access. 

How digital tools can alleviate health care access and affordability issues for women

Your monthly collection of insights from the Physicians Practice Pearls writers is available now!

Physicians Practice digital edition: Best states to practice

Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.

Her evidence-based work enables physicians to sail through the challenges of influencing others to deliver excellent care. Her clients learn simple, quick ways to lead high quality, thriving care groups – one conversation at a time. She’s an Affiliate Faculty at AriadneLabs (Brigham & Womens Hospital and Harvard’s Chan School of Public Health), as well as a scholar at Brandeis University WSRC. 

https://www.linkedin.com/in/nancegoldstein/

, curates recent research and stories of physicians making medical practice better – leadership that honors their purpose 

 improves their experience of practicing.

Her podcast offers conversations with seasoned women MDs talking about how they navigated the competing demands of practice, family and the rest of life.

She’d like to hear what troubles you in your practice. Email her: 

De-escalating situations and emotions can settle disagreements between staff members.

Messy Moments: Dial down the drama

Physicians Practice offers practical, proven solutions to the real-world concerns physicians and medical practices face every day.

Advertise

Contribute

Contact Us

Privacy

Terms and Conditions

Do Not Sell My Information

Physician's Practice | Medical Practice News | Physicians Practice

Facebook

LinkedIn

Spotlight: Career

1rem

Welcome to Perspectives, brought to you by Physician’s Practice. I'm Drew Boxler, Editor of Physician’s Practice.

Every two weeks, we will be exploring key areas of a successful, thriving, independent practice. We’ll hear from experts in the industry regarding best practices for billing and collections, answer your top coding questions, analyze current legal trends, malpractice landmines to avoid, and look at the hottest tech innovations to increase productivity and enhance the patient experience.

Today, I am pleased to feature our discussion with Dan Dooley, Vice President of physician services at R1, a leading provider of technology-enabled revenue cycle management.

Earlier this year, as the pandemic was fully setting in, we spoke with Dan about how 

likely change as a result of the pandemic.

In many ways, the pandemic has exacerbated trends that existed in the market previously. Costs have been increasing, revenues have been decreasing for some time. And so the need to more efficiently collect the revenues that are owed to our practice is, you know, something that has obviously escalated in importance here in the near term, changes in terms of digital front door strategies, allowing patients to self-serve many of the scheduling and registration requirements, and the financial clearance process is something that is increased in importance here recently. And the third being, you know, changes in the actual delivery of clinical care. And how revenue cycle supports that variation, whether it be you know, telehealth services with virtual visits, or just phone calls.

In many ways, the pandemic has exacerbated trends that existed in the market previously. Costs have been increasing, revenues have been decreasing for some time. And so the need to more efficiently collect the revenues that are owed to our practice is, you know, something that has obviously escalated in importance here in the near term, changes in terms of digital front door strategies, allowing patients to self-serve many of the scheduling and registration requirements, and the financial clearance process is something that is increased in importance here recently. And the third being, you know, changes in the actual delivery of clinical care. And how revenue cycle supports that variation, whether it be you know, telehealth services with virtual visits, or just phone calls

 One of the trending alliterations at the time of our discussion was that of the ‘new normal’. 

For physician practices and revenue cycle management, Dan said that there were three aspects to anticipate in this ‘new normal’ word.

I'd say, first and foremost, it's looking for opportunities to variable eyes, your expense structure, you know, your fixed costs, you know, and a couple areas to look at there are your vendor contracts, ensuring that the payment terms within those contracts are aligned to your volumes and your revenues. So that as those decrease, your expenses decrease correspondingly with that.

The second is really looking at opportunities to implement and or improve some of those digital front door strategies. It has a dual benefit of really meeting the consumer where they're at today, they expect to have those types of capabilities available to them. And the second benefit is it reduces any unnecessary exposure between patients and staff.

I'd say the the third area is really leveraging the financial clearance processes to be laser focused on the uninsured population. You know, obviously, over the course of the last couple months, there's been a significant growth in the unemployed. And those unemployed, people are going to require additional help to be able to secure the funding that they need to get the services that they need. And again, it has a dual benefit of improving practice profitability, but probably most importantly, patients that have insurance are more apt to seek and receive the care that they need.

 Of course, the main topic of our discussion was going to be financial clearance. Up next, Dan defines ‘financial clearance,’ and what that means, specifically, for R1.

: Well, there's multiple definitions in the market. At R1, we define the processes beginning immediately after the point of scheduling all the way through the point of receipt of clinical care. Within that, we're really looking to execute against three core parts of the process. The first being securing accurate information from the patient, both from the demographic’s perspective, coverage perspective. The second, then, is securing all the required forms for HIPAA consensus, etc. And I'd say the third and, you know, I'd argue, you know, maybe the most important right now is ensuring that patients are educated as to their coverage, their benefits, and what to expect in terms of out of pocket expense. And leveraging that process to ensure every patient is triaged into a financial risk profile so that high-risk patients that need more help in terms of actually securing funding for their services are, are helped and treated accordingly. And patients that are low risk, you're basically leveraging time that you create from triage and those patients appropriately a focus on the high-risk patients.

 To establish that financial clearance, Dan says that there are about four critical building blocks physicians need to meet.

Well, I'd say there's four. The first is ensuring that you have a strong point of view on what best practices are through that process. We define that as a set of methods that start from scheduling and go through the time of service, we break it into four key components: scheduling and orders, the pre-service financial clearance process, financial advocacy for those patients that need extra help. And the fourth being, you know, the check in process, you know, commonly referred to as registration throughout that it's an ensuring that the staff is adequately trained on all of those best practice points through the process. The second is making sure that you have technology that enables those processes, giving the staff the tools that they need to be more efficient and to adhere to those processes.

And I'd say three and four are probably the most important. It's having metrics that measure that process all the way through, both from an in-process perspective (are you getting coverage verification 100% of the time, to the outcome metrics in terms of what's happening with your denial rates? how effectively Are you collecting patient out of pocket, etc.) and an accountability structure that allows you to see daily basis, monthly basis, weekly basis, quarterly basis? Educate your staff help your staff to be more successful?

 To optimize your financial clearance process, Dan says that you should follow the following specific steps.

Well, I'd say first and foremost, it's getting the basics right on the uninsured population. So, 100% of the time making sure that you are adhering to those best practice points and executing against that process, so that you're optimizing the collections that you're getting from the patients that do have insurance.

After that, it's being able to triage that patient population effectively to understand which ones are at higher risk for not being able to pay. So that starts with screening, all of your own insured patient should be screened to identify which funding sources they may qualify for. After you've identified some potential funding sources, it's providing them with the help that they need to actually move through the process of securing that funding. So, some patients are able to do that more effectively than others. And so again, if that triage mechanism allows you to ensure that you're kind of holding their hand through what can be a very challenging process with federal government guidelines, state government guidelines, and community programs that are available.

 One way to improve financial clearance is to utilize new technology. For example, Dan says that automation is a good technology to use. 

Up next, hear how this technology can benefit your financial clearance process.

Well, automation has the dual benefit of increasing efficiency and increasing adherence to the process. You know, so some examples of automation, you know, are to 70 to 71, coverage, verification, automation, automation around ensuring that authorizations have been secured, and that the payer recognizes those.

All of those are sort of basic process steps that free up time and allow you to focus on those patients that have the need for sort of greater follow up or more complex treatment in the financial clearance process. Getting more advanced on automation, you're able to then start to initiate processes where patients can self-serve smart questionnaire forms that help guide them to specific funding sources that maybe available to them, and really starting to hardwire processes that allow you to ensure that you're hitting all of your metrics effectively

 As you are streamlining your financial clearance processes, you will need to look out for particular KPIs or performance metrics. Dan says that the following are the most important for physicians to pay attention to.

Well, at R1, we have roughly 39 metrics that we apply to those points in the financial clearance process I was describing.

I'd say it in terms of those metrics, there's probably two ways to answer that question. One, it's really key that you have an in-process metrics and outcome metrics. So it's about having the metrics you need to be able to monitor the staffs execution against the process as designed, and then monitor the outcomes of that process so that you can identify defects that lead to continuing improvements and collection rates.

Some examples of that would be from an in-process metrics perspective: it's your authorization complete rate, your coverage verification rate, “what rate did I educate my patients that were coming in in terms of their benefits?”, you know, copay, ask rate, etc. From an outcome metric perspective, it's going to be things such as denials, denial rates, collection, yield against patient out of pocket, etc.

 Finally, Dan offered some specific goals that practices should be aiming to reach. 

The goals are going to vary based on a practice’s unique situation, so it's really more about the journey of improvement than the specific goal, as it relates to outcome metrics. On the in-process metrics, it's about executing those 100% of the time. And so you do that by, you know, having an analytic layer that allows you to monitor that on a daily basis, provide feedback in real time to your office staff or t o yours support staff in to in relationship to the performance, identify improvement opportunities, etc. And so that's, that's really the key.

And thank you all for listening to this eighth episode of Perspectives, brought to you by Physician’s Practice.

We hope you subscribe where you listen to podcasts, rate us, and let us know what topics you would like to hear more about.

For more practice management insights from the top experts in the field, be sure to visit us at 

Physician’s Practice® presents our conversation Dan Dooley, vice president of physician services at R1—a leading provider of technology--enabled revenue cycle management—about how the pandemic will change revenue cycle management, as well as how practices can achieve financial clearance and thereby further support their patients. 

Financial clearance, patient advocacy, and the effects of the pandemic on revenue cycle management

. In this podcast, we'll bring you some of the most interesting and influential guests in healthcare. If you have any ideas for podcast guests or topics, email us at 

We're picking up where we left off with Halee Fischer-Wright, MD, president of the Medical Group Management Association, in this edition of the 

 which opined that healthcare needs the three elements of medicine - art, science, and business - to w

, Fischer-Wright talked to us about the lost humanity of medicine, George Clooney, and her own flirtation with medical bill-induced bankruptcy. In part two of our conversation, she talks about the high cost of managing and reporting quality measures, specifically what it will take for providers to be able to successfully track quality in a value-based environment.

"Clearly reporting quality...is not yielding the outcomes we want. We have to ask ourselves a very fundamental question: What is value? I'm not talking about the business school [definition]…what do we really value? What is valuable to us as a physician, us as a practice, and us as a patient? That's the outcome we want. Then we need to work backwards to say what are the processes, protocols, the things we need to do to achieve those goals," she says.

Fischer-Wright also talks about Women's Health Associates in Portland, Ore. and how they learned the hard way about what patients want. She also offers some main takeaways from her book and some overarching advice for practices looking to achieve balance. "There has never been a time in the history modern practice….that we have [this kind of opportunity] to create our future. People in medical practice aren't victims, we're actually empowered to make the changes we want and our patients want, to make ourselves and our patients happier," she says.

Click above to play part one of the podcast.

In her book, Halee Fischer-Wright says there has been misguided efforts to define value in healthcare and it needs to be re-examined.

Revenue Cycle Management

Latest News